STORZ MEDICAL – Literature Databases
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Han S. et al., 2022: Per-oral pancreatoscopy-guided lithotripsy vs. extracorporeal shock wave lithotripsy for treating refractory main pancreatic duct stones in chronic pancreatitis: Protocol for an open-label multi-center randomized clinical trial.

Han S, Miley A, Akshintala V, Freeman ML, Kahaleh M, Othman M, Patel S, Papachristou GI, Raijman I, Sankey N, Sayana H, Singh V, Tarnasky P, Trikudanathan G, Shah RJ.
Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, United States.
Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
Division of Gastroenterology and Hepatology, Johns Hopkins Medicine, Baltimore, MD, United States.
Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN, United States.
Division of Gastroenterology, Rutgers Robert Wood Johnson, New Brunswick, NJ, United States.
Division of Gastroenterology, Baylor College of Medicine, Houston, TX, United States.
Division of Gastroenterology, UT Health San Antonio, San Antonio, TX, United States.
Division of Gastroenterology, Baylor St. Luke's Medical Center, Houston, TX, United States.
Department of Urology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
Division of Gastroenterology, Methodist Dallas Medical Center, Dallas, TX, United States.
Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.

Abstract

Backgrounds/objectives: Patients with chronic pancreatitis may develop pancreatic duct stones that can obstruct outflow leading to ductal hypertension and pain. Both endoscopic retrograde pancreatography (ERP) with per-oral pancreatoscopy (POP) and intraductal lithotripsy and extracorporeal shock wave lithotripsy (ESWL) are feasible options to attempt ductal stone clearance. This study aims to compare POP-guided lithotripsy with ESWL in the management of refractory symptomatic main pancreatic duct stones.

Methods: This is an open-label, multi-center, parallel, randomized clinical trial. Patients with chronic pancreatitis and main pancreatic duct stones ≥5 mm who fail standard ERP methods for stone removal will be eligible for this study. In total, 150 subjects will be randomized 1:1 to either ESWL or POP. A maximum of 4 sessions of either ESWL or POP will be allowed in each arm, with crossover permitted thereafter. The primary outcome is complete stone clearance and secondary outcomes include quality of life, pain scores, number of interventions, and daily opiate requirements.

Conclusions: This study aims to answer the question of which lithotripsy method is superior in removing refractory pancreatic duct stones while addressing the effects of lithotripsy on quality of life and pain in patients with chronic calcific pancreatitis (ClinicalTrials.gov NCT04115826).
Pancreatology. 2022 Dec;22(8):1120-1125. doi: 10.1016/j.pan.2022.09.245. Epub 2022 Oct 15. PMID: 36273991.

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Comments 1

Peter Alken on Sunday, 19 March 2023 09:30

America is different in many ways. I was surprised to read in the discussion again that in the US predominantly urologists and not gastroenterologist do ESWL for pancreatic stones. I had a look at a recent publication addressing that fact (1) to recall the numbers. When ESWL was logistically changed from urologists to gastroenterologists more patients underwent same-session endoscopic treatment (66% vs 6%) more patients had complete duct clearance (71% vs 44%) and less patients were hospitalized following ESWL (1). It is comparable to the establishment of the percutaneous access for PNL frequently done by Radiologist in the US. It seems that professional considerations are sometimes more important than optimal patient care.

1 Jaben IL, Coté GA, Forster E, Moran RA, Broussard KA, Scott N, Cotton PB, Keane T, Elmunzer BJ. Comparison of Urologist- vs Gastroenterologist-Directed Extracorporeal Shock Wave Lithotripsy for Pancreaticolithiasis. Clin Gastroenterol Hepatol. 2021 Jun;19(6):1234-1239. doi: 10.1016/j.cgh.2020.07.042. Epub 2020 Jul 23. PMID: 32712398; PMCID: PMC8786309.
Free PMC article

Peter Alken

America is different in many ways. I was surprised to read in the discussion again that in the US predominantly urologists and not gastroenterologist do ESWL for pancreatic stones. I had a look at a recent publication addressing that fact (1) to recall the numbers. When ESWL was logistically changed from urologists to gastroenterologists more patients underwent same-session endoscopic treatment (66% vs 6%) more patients had complete duct clearance (71% vs 44%) and less patients were hospitalized following ESWL (1). It is comparable to the establishment of the percutaneous access for PNL frequently done by Radiologist in the US. It seems that professional considerations are sometimes more important than optimal patient care. 1 Jaben IL, Coté GA, Forster E, Moran RA, Broussard KA, Scott N, Cotton PB, Keane T, Elmunzer BJ. Comparison of Urologist- vs Gastroenterologist-Directed Extracorporeal Shock Wave Lithotripsy for Pancreaticolithiasis. Clin Gastroenterol Hepatol. 2021 Jun;19(6):1234-1239. doi: 10.1016/j.cgh.2020.07.042. Epub 2020 Jul 23. PMID: 32712398; PMCID: PMC8786309. Free PMC article Peter Alken
Saturday, 02 December 2023